Seminary and Yeshiva students studying in Israel for the 2018-2019 school year should enter their permanent home address.

City: *

State: *

Zip Code: *

Country: *

Phone Number: *

Cell Phone:

Email Address: *

Confirm Email Address: *

Gender: *

Male Female

Date of Birth: *

I am a: (Determines Minimum Fundraising Amount)*

I am a group high school student within the New York Tri-State area or Ontario/Quebec area and will require group air fare and hotel stay (based on double or triple occupancy) and agree to raise a minimum of $2950 by February 5, 2019.

I am a group high school student outside the New York area Tri-State or Ontario & Quebec area and will require group air fare and hotel stay (based on double or triple occupancy) and agree to raise $3050 by February 5, 2019.

I am a College /Hillel student within the New York Tri-State area or Ontario/Quebec area and will require group air fare and hotel stay (based on double or triple occupancy) and agree to raise a minimum of $2950 by February 5, 2019.

I am a College /Hillel student outside the New York Tri-State area or Ontario & Quebec area and will require group air fare and hotel stay (based on double or triple occupancy) and agree to raise $3050 by February 5, 2019.

I am a Seminary/Yeshiva within the New York Tri-State area or Ontario/Quebec area and will require group air fare and hotel stay (based on double or triple occupancy) and agree to raise a minimum of $2950 by February 5, 2019.

I am a Seminary/Yeshiva student outside the New York Tri-State area or Ontario & Quebec area and will require group air fare and hotel stay (based on double or triple occupancy) and agree to raise $3050 by February 5, 2019.

I am an individual adult runner and will require air fare and hotel stay (based on double occupancy) and agree to raise a minimum of $3950 by February 5, 2019.

I am a family of 2 (or more) and will require air fare and hotel stay (based on double occupancy) and agree to raise a minimum of $3450 each by February 5, 2019.

I am part of a Group (10+ participants) and will require air fare and hotel stay (based on double occupancy) and agree to raise a minimum of $3450 each by February 5, 2019

I am a high school chaperone within the New York Tri-State area or Ontario/Quebec area and will require group air fare and hotel stay (based on double or triple occupancy). In the event that my school does not have 10 recommitted students by January 5, 2019 I agree to raise a minimum of $2950 by February 5, 2019.

I am a high school chaperone outside the New York area Tri-State or Ontario & Quebec area and will require group air fare and hotel stay (based on single occupancy). In the event that my school does not have 10 recommitted students by January 5, 2019 I agree to raise $3050 February 5, 2019.

I understand that a surcharge of $300, payable to GoInspire, will apply to all registrations received after January 25, 2019.

Is this your first time in Israel? *

Yes No

Occupation: *

Employer:

Education

High School: *

Grade: *

Graduating Year: *

High School: *

Education

College/Seminary/Yeshiva: *

Graduating Year: *

Parent Contact Information

Name: *

Phone: *

Email: *

Emergency Contact Information

Name: *

Phone: *

Email: *

Relationship: *

Login Information

Please create a password in order to access the participant and training sections of the website.

Participants running a full marathon must be 18 years old by March 15th, 2019.

Estimated Finish Time: *

:
:

Passport Number *

Issuing Country*

Other Issuing Country *

Expiration Date *

*PLEASE NOTE: All visitors to Israel must hold a passport that is valid for
at least six months from the date they are departing the country.

If your passport is in the process of renewal, please indicate your current passport number and expiry date and inform us the new details when available.

Raise more. Give more. Get more.

Runners are only required to reach their minimum fundraising targets. But if you raise more, you get more!

bronze

(students only)

$4,000+ per runner

Recognition and award presented at the Pasta Party for your outstanding support

Exclusively designed Shalva necklace/key chain

"First Aid" Max Brenner Gourmet Chocolate Box

silver

(adults only)

$7,200+ per runner

Recognition and award presented at the Pasta Party for your outstanding support

Exclusively designed Shalva necklace/key chain

"First Aid" Max Brenner Gourmet Chocolate Box

Bottle of limited edition Shalva wine from the Tulip Winery

Fresh fruit platter upon arrival

Upgrade to private superior room

Executive floor privileges

Fitness center privileges

gold

(adults only)

$10,800+ per runner

Recognition and award presented at the Pasta Party for your outstanding support

Exclusively designed Shalva necklace/key chain

"First Aid" Max Brenner Gourmet Chocolate Box

Bottle of limited edition Shalva wine from the Tulip Winery

Fresh fruit platter upon arrival

Upgrade to a private suite

Executive floor privileges

Fitness center privileges

Voucher to Genesis Restaurant

Pre or post-race massage

Team Shalva T-shirt

As a Team Shalva participant you will receive a complimentary Team Shalva 'tech T-shirt' to be worn at the Jerusalem Marathon. Please indicate your size.

Size: *

Recruitment Information

Have you participated with Team Shalva before: *

Yes No

Year: *

Check all that apply

2018
2017
2016
2015
2014
2013
2012
2011
2010

How did you hear about us? *

Please specify: *

Personal Connection

If there is someone whose honor or memory you wish to train for, please indicate below:

In Memory OfIn Honor OfFor The Recovery Of

Name

If you would like us to send an acknowledgement of your participation in Team Shalva to your personal honoree or his/her family, please indicate where the acknowledgement should be sent:

Billing Information

The registration fee is non-refundable and is not transferrable. You will be required to sign a fundraising recommitment letter by January 5, 2019. In the very unlikely event you decide not to participate, you may do so without any additional obligation up until your respective recommitment date.

Registration Fee is $100.

Coupon Code:

If you have a coupon code please enter it below.

You will be charged a $ registration fee.

Card Type: *

Card Number: *

Exp. Month: *

Exp. Year: *

Security Code: *

Waiver and Release

I have read the above waiver and I accept and agree to the terms set forth therein.

I accept the above waiver for my child and I accept and agree to the terms set forth therein.

I am a high school chaperone. In the event my high school team does not have 10 students enrolled in the team
I agree to raise $ by February 5, 2019.

Additional Comments:

IMPORTANT!!! Please note that although you will receive a thank you message and email upon completing this form, your registration will not be activated until the Cardcom form and payment on the next page is submitted.

SECURITY CHECK - Please check to confirm you are not a robot

Please click on “REGISTER” and you will be directed to your “Sign-In" Page.You’re
just a few clicks away from creating your own race web page.

Please
wait a moment while we process your request.Do not hit the "Register" button
more than once!